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Discussion

NIHSS

Hi I work on a newly opened intergrated stroke unit and We are going to initiate the Nihss stroke scale into our nursing practice instead of using the cnss and I want to now how often are other facilities doing the nihss for each stroke patient. As of now the cnss is being assessed every 4 hours and it was proposed that we complete an nihss every 4 hours as well but to me that just seems unrealistic.

Anyone have any advice or research based evidence that I can bring forward to my facility.

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    The only evidence based use of the NIH scale is prior to tPA, where it can be predictive for the risk of hemorrhagic complications, otherwise it serves no established purpose in guiding care. Serial NIH scores can be useful if they are being used to evaluate the effectiveness of tPA treatment by an organization that is contributing to tPA effectiveness databases, but even then it's only indicated pre-tPA, 2 hours post tPA, and at discharge.

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    I work in a stroke certified hospital. We NIH once a shift to monitor patient progress, but this is not a certification requirement. I don't believe so anyway. It's just our policy. Q4 hour is a waste. Q2-4 Neuro assessments are good practice depending on if they are TIA OBS vs a confirmed stroke. But doing a whole NIH will not change the plan of care for that patient and is a waste of time.

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